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Psychiatric Nursing

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  • 1. PSYCHIATRIC NURSING Philadelphia Las Vegas April 2-5, 2014 April 27 - 30, 2014 REGISTER BY FEBRUARY 19 FOR PHILADELPHIA MARCH 17 FOR LAS VEGAS SAVE UP TO $80 EARN UP TO 25.5 CE hours - Philadelphia 24.25 CE hours - Las Vegas PRECONFERENCES PHILADELPHIA – APRIL 2 LAS VEGAS – APRIL 27 REGISTER ONLINE AT CONTEMPORARYFORUMS.COM OR BY CALLING 800-377-7707
  • 2. CONTEMPORARYFORUMS.COM PSYCHIATRIC NURSING | PHILADELPHIA/LAS VEGAS | 2014 | #PSYCH14 You’re Invited! As we begin to think about psychiatric-mental health nursing in 2014, we all realize that more change is heading our way. The DSM-5 has been published, and continues to raise challenging issues for practitioners and researchers. Health care policy will continue to be a hot topic as the Affordable Care Act transitions to reality. Recovery principles, integrated care, evidence-based practice, and the essential connection with our clients will remain of critical importance to achieve best-possible outcomes. How do we begin and continue to prioritize and incorporate these elements into treatment strategies and decisions? The 2014 Psychiatric Nursing Conferences offer a forum for discussion and the exchange of ideas, as well as the opportunity to advance your knowledge and take home clinical pearls. We know you’ll be energized by attending and challenged to examine what you do with a new perspective. Though we recognize that the challenges can be intimidating, we should also recognize the opportunities that addressing and meeting them will provide! Historic Philadelphia and dazzling Las Vegas provide outstanding and unique location choices for the Psychiatric Nursing Conferences. Invite your team members to join you at one of these “must attend” events to learn, relax and network. See you there! WHO SHOULD ATTEND? X Staff Nurses X Nurse Practitioners X Clinical Nurse Specialists X Nurse Managers X Educators/Instructors X Private Practitioners/ Consultants X Case Managers CONFERENCE OBJECTIVES THESE CONFERENCES WILL ENABLE THE EXPERIENCED CLINICIAN TO: X Examine the expanding roles and opportunities for psychiatric nurses and advanced practice nurses as we transition to new national healthcare policies. X Describe trauma-informed care principles and strategies to implement them in practice. X Investigate how and why the DSM-5 has created challenges and controversy, and ways in which the issues are being addressed. X Outline evidence-based therapeutic interventions for selected psychiatric disorders. X Gain insight into the consumer’s perspective of mental health care and treatment.
  • 3. HIGHLIGHTS & BENEFITS OF THE 2014 CONFERENCE AN INTRIGUING CHOICE OF PRECONFERENCES AT THE TWO CONFERENCE LOCATIONS! PHILADELPHIA (EACH A HALF-DAY) X X From Patient to Person to Parent: A Journey of Resilience and Recovery with Serious Mental Illness, Trauma and Suicidality. Our speaker is Eric Arauz Each attendee at this Preconference will receive a complimentary copy of his book “An American’s Resurrection: My Pilgrimage from Child Abuse and Mental Illness to Salvation”. PROGRAM FEATURES X Let’s Talk: Hot Topics in Psychiatric Nursing, an optional after-lunch forum in both locations allowing you to ask questions, state your opinions and learn about what’s happening at other facilities. X Trauma-informed care, building competency in inpatient suicide risk assessment and prevention. telepsychiatry, DSM-5 updates, early intervention in schizophrenia, co-managing medical and psychiatric health issues—just a sampling of topics addressed. X 16 Concurrent Sessions from which to choose to create a conference experience that will meet your educational needs and interests. X Access to leaders in psychiatricmental health nursing and education. PTSD, Substance Abuse and Sleep Disruption: A Treatment Conundrum Across the Lifespan, our psychopharmacology Preconference focusing on the treatment of PTSD and related diagnoses. LAS VEGAS (EACH A FULL DAY) X X Molecules and Circuitry: Understanding and Managing Psychopharmacotherapy in the 21st Century, a Preconference addressing treatment of common psychiatric disorders based on common neurochemical characteristics. Psychiatric Nursing in a Time of Sexual Violence, focusing on the assessment and treatment of post-violence sequelae, including role-playing scenarios by the speakers. WE ARE HONORED TO HAVE ERIC ARAUZ SPEAK ABOUT HIS JOURNEY TO RECOVERY AT OUR CONFERENCES IN BOTH PHILADELPHIA AND LAS VEGAS! Eric’s history includes child abuse at the hands of a mentally-ill father, multiple hospitalizations in maximum-security psychiatric wards, bipolar 1 disorder, PTSD from trauma that occurred during hospitalization, and alcohol and drug addiction. Today, Eric holds Bachelors and Masters Degrees from Rutgers, trains and speaks through his consulting firm AIE, is an adjunct instructor in the Department of Psychiatry at UMDNJ/ Robert Wood Johnson Medical School, and serves as Vice Chair of Governor Christie’s NJ Task Force on Heroin and Other Opiate Use by NJ Youth and Young Adults. Eric has also been honored as a 2009 SAMHSA/US Department of Health and Human Services “Voice Award” recipient; a 2012 SAMHSA “Voice Award” Fellowship winner and a faculty member for SAMHSA’s five-year Recovery to Practice grant. Most recently he has worked with national nursing leaders to create nursing competencies that address suicide prevention and intervention on inpatient units. In 2012, Eric published his first book, An American’s Resurrection relating his triumph over his personal demons. Eric will share his experiences and remarkable recovery journey, emphasizing resiliency and the importance of critical connections that have allowed him to do what he does today.
  • 4. PSYCHIATRIC NURSING SCHEDULE HIGHLIGHTS PHILADELPHIA LAS VEGAS PRECONFERENCE A (MORNING) PRECONFERENCE A (ALL DAY) From Patient to Person to Parent: A Journey of Resilience and Recovery with Serious Mental Illness, Trauma and Suicidality Molecules and Circuitry: Understanding and Managing Psychopharmacotherapy in the 21st Century PRECONFERENCE B (AFTERNOON) PRECONFERENCE B (ALL DAY) PTSD, Substance Abuse and Sleep Disruption: A Treatment Conundrum Across the Lifespan Psychiatric Nursing in a Time of Sexual Violence GENERAL SESSIONS 2014 and Beyond: Implications of the Changing Healthcare World for Psychiatric Nursing How to Come Alive When You’ve Lost All Hope: The Importance of Making a Connection Trauma-Informed Care: Principles in Practice Neurobiology of Addiction and Pharmacologic Concepts ROUNDTABLE LUNCH WITH FACULTY (Optional) DSM-5 One Year Later: Changes, Challenges and Controversies Risk Management Strategies: What Every Nurse Should Know CBT for IBS? Functional GI Disorders: At the Intersection of Panic Disorder and Social Anxiety GENERAL SESSIONS DSM-5 One Year Later: Changes, Challenges and Controversy Psychopharmacology Update: Hits, Misses and New Advances Is this Addiction? Considerations in Managing Chronic Pain in the Context of Concerning Patient Behaviors Mindfulness Based Interventions for Psychopathology AFTER-LUNCH FORUM (Optional) Let’s Talk: Hot Topics in Psychiatric Nursing How to Come Alive When You’ve Lost All Hope: The Importance of Making a Connection Institutional Renewal: Our Pilgrimage from the Tradition of Toughness to Trauma-Informed Care Love in a Time of Violence Tele-Psychiatry: A Growing Element of Psychiatric Practice and an Opportunity for Nurse Practitioners AFTER-LUNCH FORUM (Optional) Let’s Talk: Hot Topics in Psychiatric Nursing The Ultimate Guide to License Protection: Top 10 Ways to Avoid a Board Complaint Functional MRIs and Psychiatric Nursing in the 21st Century Un-Handcuffing Your Relationship with Law Enforcement: Educating Officers About Mental Illness Adult ADHD: Recognition and Treatment What’s the Right Thing to Do (or Not?) Everyday Ethics in Treating Vulnerable Populations Psychopharmacology Update: Hits, Misses and New Advances CONCURRENT SESSIONS #1 #P-11* Countertransference: The Many Ways Patients Push Our Buttons #P-12+ Childhood Obesity and the Social and Psychological Effects #P-13 #P-14 Co-Morbid Medical and Psychiatric Issues Trauma Theory and Impact CONCURRENT SESSIONS #2 #P-21* How to Effectively Run Groups and Integrate into APN Practice #P-22+ Autism Spectrum Disorder and the DSM-5 #P-23 #P-24 Psychopharmacology of Bipolar Disorder and Mood Dysregulation Trauma-Informed Care Implementation CONCURRENT SESSIONS #3 #P-31* Psychiatric Advanced Practice Nurses in Primary Care Settings: Strategies for Integrating Mental Health Assessment #P-32+ Disruptive Mood Dysregulation Disorder: A New DSM-5 Diagnosis in Children #P-33 Diagnostic Inflation in the DSM-5: #P-34 Does Normal Need Saving? Treating Anxiety Disorders Using Complementary Alternative Medicine CONCURRENT SESSIONS #4 #P-41* CPT Changes of 2013: Practice Tips and Discussion on How to Bill, Code and Document Properly #P-42+ It’s Normal to be Normal: What You Need to #P-43 #P-44 Know About Physical Assessment and Psychological Indicators of Child Sexual Abuse Early Intervention in Schizophrenia: Issues in Implementing a New Model of Treatment for First-Episode Psychosis Fanning the Flame Within: Activating Health Behavior Change * = Advanced Practice + = Child/Adolescent Using Assessment Tools Effectively in Documenting Outcomes Stigma Busters: The Future of Psychiatric Nursing CONCURRENT SESSIONS #1 #L-11* Implementing Telemental Health: #L-12 #L-13 #L-14 Clinical Challenges and Pragmatic Examples Moving Towards Competency in Inpatient Suicide Prevention and Intervention Boundaries, Boundaries, Boundaries: Understanding and Managing Manipulative Behaviors Repetitive Transcranial Magnetic Stimulation for Treatment of Depression: Treater and Patient Perspectives CONCURRENT SESSIONS #2 #L-21* What Are We Missing When We Don’t Think Beyond Depression? Differential Diagnosis #L-22 Trauma Inherent to Mental Illness and Its Treatment #L-23 Sensitive and Targeted Assessment for Alternative Lifestyle Patients # L-24 Diagnostic Inflation in the DSM-5: Does Normal Need Saving? CONCURRENT SESSIONS #3 #L-31* Medication Assisted Treatment for Opiate Use Disorders: Barriers and Solutions to Effective Use of APRNs #L-32 Early Intervention in Schizophrenia: Issues in Implementing a New Model of Treatment for #L-33 #L-34 First-Episode Psychosis Legal Ramifications in Psychiatric Nursing: Case Studies and Real Case Outcomes The Patient Who Self-Injures: Why Do They Cut? CONCURRENT SESSIONS #4 #L-41* Evidence Based Practice for Trauma and #L-42 #L-43 #L-44 Stress Related Disorders This Ain’t No Three-Ring Circus: Managing Acute Inpatient Psychiatric Symptoms Heart and Brain: Co-Managing Psychiatric and Cardiac Conditions Sensory Interventions: Implementation of Strategies to Soothe the Body and Calm the Mind
  • 5. CONFERENCE TO REGISTER, COMPLETE, DETACH, AND RETURN THE APPLICATION MAILER TO CONTEMPORARY FORUMS. FACULTY (COMBINED) PLANNING COMMITTEE MEMBERS Lisa Alberts, APRN-BC, PMHNP-BC Pamela E. Marcus, MS, APRN/PMH-BC PHILADELPHIA Eric C. Arauz, MLER Joan Kenerson King, MSN, RN, APRN, BC Suzanne Brennan, PhD, RN Brenda Marshall, EdD, PMHNP-BC Pearl English, DrNP(c), MS, RN Laura G. Leahy, DrNP(c) APRN, PMH-CNS/FNP, BC Margaret (Peggy) Jordan Halter, PhD, APRN John R. McQuaid, PhD Christine Mulligan, APRN, PMHNP-BC, PMHCNS-BC Melissa Hunt, PhD, ACT Charles Primich, MSN, PMHNP-BC LAS VEGAS Elizabeth D. Kryak, DrNP(c), MSN, RN-BC Tracy L. Singh, RN, JD Paul Thomas Clements, PhD, APRN, BC, CGS , DF-IAFN Mary Lavery-Fisher, MSN, APRN BC, FNP/CNS, JD Josh Hamilton, DNP, RN-C, FNP-C, PMHNP-BC, CNE Gail K. Leslie, MS, PMHCNS-BC Mary Ann Nihart, MA, APRN, PMHNP-BC, PMHCNS-BC Barbara J. Limandri, PhD, PMHCNS-BC Richard Pessagno, DNP, APRN, BC Gail Stern, MSN, RN, PMHCNS-BC Nan Stromberg, MSN, PMHCNS-BC William J. Lorman, PhD, MSN, PMHNP-BC, CARN-AP Matt Tierney, MS, RN, PMHNP-BC, CNS Anne Troy, MN, RN, FNP-BC, LNC, SANE Merritt Widen, CEO Jeannine Loucks, MSN, RN-BC, PMH FOR COMPLETE FACULTY BIOS, PRECONFERENCE DESCRIPTIONS AND SCHEDULES, INCLUDING SPEAKERS, TIMING AND PHARMACOLOGY CREDIT, VISIT CONTEMPORARYFORUMS.COM ACCREDITATION A Certificate of Attendance will be available online after you complete the course requirements, enabling you to register your credit with the appropriate licensing boards or associations. To apply for credit not listed below, use the procedure established by the specific organization. A B MAIN CONFERENCE AFTER LUNCH FORUM 4 ANCC/ 4.8 CA BRN 4 ANCC/ 4.8 CA BRN 16.5 ANCC/ 19.8 CA BRN 1 ANCC/ 1.2 CA BRN N/A 4 HOURS 4.25 HOURS AVAILABLE N/A A B MAIN CONFERENCE AFTER LUNCH FORUM 1 NURSES AND NURSE PRACTITIONERS 7.25 ANCC/ 8.7 CA BRN 7 ANCC/ 8.4 CA BRN 16 ANCC/ 19.2 CA BRN 1 ANCC/ 1.2 CA BRN PHARMACOLOGY CREDIT FOR PRESCRIPTIVE AUTHORITY 7.25 HOURS N/A 4 HOURS AVAILABLE N/A PHILADELPHIA 1 NURSES AND NURSE PRACTITIONERS PHARMACOLOGY CREDIT FOR PRESCRIPTIVE AUTHORITY LAS VEGAS SOCIAL WORKERS/ 7.25 CE MARRIAGE, FAMILY & CHILD COUNSELORS CREDIT HOURS 7 CE 16 CE CREDIT HOURS CREDIT HOURS N/A Contemporary Forums is accredited as a provider of continuing nursing education This conference has been approved by the Washington Chapter, National by the American Nurses Credentialing Center’s Commission on Accreditation. Association of Social Workers (NASW) for Licensed Social Workers, Licensed Marriage & Family Therapists and Licensed Mental Health Counselors, Contemporary Forums is approved by the California Board of Registered Nursing, Provider #1975-148. (Las Vegas only) Provider #04516. (CA BRN contact hour = 50 minutes) This course meets the qualifications for continuing education credit hours Rx indicates pharmacology content. Because states’ requirements vary, for Marriage, Family & Child Counselors and/or Licensed Clinical Social Workers contact your Board of Nursing for more information. as required by the California Board of Behavioral Sciences, Provider #PCE771. (Las Vegas only) Case Managers: Application has been made for continuing education credit from the Commission for Case Manager Certification.
  • 6. EARN YOUR CE CREDIT ONLINE AT YOUR CONVENIENCE WITH OUR ONLINE CE LIBRARY! Great conference for discussing information that is personally, as well as professionally compelling. I would recommend it to all psychiatric nurses! Roz Kravitz, RN PHILADELPHIA, PA Can’t attend these live conferences? Register for online access to the recorded Philadelphia conference before April 2, 2014 for special pre-order discount. COST IS $335 AND INCLUDES: X Access to all recorded Preconference and Main Conference presentations in a multimedia format for 2 years. X Online post-tests to earn over 40 hours of ANCC credit and up to 8.25 hours of Pharmacology Credit for Prescriptive Authority. X Share online conference with 3 colleagues at no cost (Post-tests for CE credit optional for colleagues, $10 per session.) X Recorded sessions will be available at OnlineCELibrary.com approximately 2 weeks after the end of the live conference. Access instructions and Conference Code will be emailed to you. X Place your order today by registering for this meeting online at ContemporaryForums.com and selecting the Online CE Library option or mail/fax the Registration Form. ONLINE CE LIBRARY GROUP DISCOUNTS Provide your staff with high-quality continuing education and give your budget a break with an Online CE Library Group Access Account. Organizations of any size can create customized CE programs for staff education and development. To request group account pricing and details, visit OnlineCELibrary.com or call (925) 361-4811. Excellent! The speakers were very approachable and informative. You could tell that they really enjoyed sharing and teaching. I will definitely be back next year! Jennifer L. James, PMHNP-BC ANACOCO, LA
  • 7. CONFERENCE INFORMATION Registrations must include full tuition payment to be accepted. Registrations faxed without payment will not be processed. Conference communications are sent via email. When registering please provide attendee’s best email address as some emails are filtered and blocked. Since conference registration and hotel rooms are limited, early registration is advised. PRECONFERENCES MAIN CONFERENCE Early Registration $135 each $485 Regular Registration $165 each $535 PRECONFERENCES MAIN CONFERENCE Early Registration $225 $485 Regular Registration $255 $535 PHILADELPHIA LAS VEGAS 4 EASY WAYS TO REGISTER: ONLINE (CREDIT CARD ONLY) Visit us 24 hours a day at: ContemporaryForums.com PHONE (CREDIT CARD ONLY) (800) 377-7707 Monday – Friday 8am - 5pm, Pacific Time BEFORE CALLING, COMPLETE ALL REGISTRATION INFORMATION. FAX PHILADELPHIA LAS VEGAS February 19, 2014* March 17, 2014* (800) 329-9923 Continental breakfasts, refreshment breaks, Certificate of Attendance and online access to posted presentation handouts before and after the conference. In addition, you will have complimentary access to the recorded sessions posted after the conference at contemporaryforums.com for one year. Continental breakfasts, refreshment breaks, Certificate of Attendance and online access to posted presentation handouts before and after the conference. MAIL (CREDIT CARD OR PURCHASE ORDER) EARLY REGISTRATION DEADLINE TUITION INCLUDES Attn: Registrar 6377 Clark Ave. Suite 200 Dublin, CA 94568 *Payments postmarked or telephone/fax registration made with credit card on/before the dates listed qualify for the early registration fee. Out of consideration to registrants, children of any age and spouses may not attend the sessions. GROUP DISCOUNTS Tuition discounts are given to groups of 3 or more registering for the complete conference. To qualify for the group discount, all registration information must be complete for all group members, payment included and forms sent together. If faxing, listall group members on cover sheet. Subtract the discount from the tuition fee. Groups may not be formed after individual registrations are received. FOR 3 OR 4 IN A GROUP: $25 per person discount, FOR 5 OR MORE IN A GROUP: $45 per person discount. PROGRAM CHANGES Contemporary Forums reserves the right to make necessary changes in speakers, topics or schedule. The most current program can be found on our website. QUESTIONS? Contact Contemporary Forums at (800) 377-7707. M–F, 8 a.m. – 5 p.m. (PST) or email: info@cforums.com SPECIAL REQUESTS PARTIAL ATTENDANCE Online registration is not available. To register, call Contemporary Forums for tuition and CE credit for individual days. Group discounts do not apply. Registrations may not be shared. If you require special arrangements at this conference, call (800) 377-7707, at least 30 days prior to the conference. TRAVEL DISCOUNTS CANCELLATIONS FEB 19 MAR 17 Cancellations may be made by phone or in writing. Cancellations received on/before February 19, 2014 for Philadelphia and March 17, 2014 for Las Vegas receive a full tuition refund. Cancellations received after that date are assessed a $75 processing fee. No refunds for cancellations received after the conference begins or for “no shows.” If this meeting is cancelled for any reason, including labor strikes or acts of God, liability is limited to a full refund of registrvation fees. CONTEMPORARY FORUMS IS A DIVISION OF AMERICAN CAREER COLLEGE. Contemporary Forums has a special discount agreement with United Airlines unavailable to the general public. To obtain these special conference fares visit united.com or (800) 426-1122 insert Offer Code ZQT4365370. Ticketing and payment can be done directly by you or through your travel agent. To ensure the best flights and times, since seats are limited, make your reservations early. Fares are guaranteed at the time of the ticket purchase. Hertz is the official car rental agency for the conference. Special rates will be in effect throughout the conference as well as one week before and after. For special rates and reservations, call HERTZ at (800) 654-2240 or (405) 749-4434, or go online at www.hertz.com and refer to Contemporary Forums plus the conference discount code CV#03000261.
  • 8. HOST CITIES: PHILADELPHIA LAS VEGAS Birthplace of Liberty, Independence and the American spirit – vibrant with celebrated sites and legendary addresses, famous venues of art, culture, entertainment, and five-star dining and shopping – the city of “America’s Friendliest People” offers a year-round invitation to enjoyment! Viva Las Vegas … it’s impossible to resist the excitement of the neon lights, the shrieks of delight from jackpot winners, and the glitz and glamour of the hotels on the strip. A Disneyland for adults? You bet … and Las Vegas is so much more! “Philly” is a taste of the old, spiced with the new. Enjoy the grandeur of the flag-lined Benjamin Franklin Parkway countered by the trendy boutiques and street entertainers of South Street. The Independence Visitor Center gives you a peek at all there is to do in Philly. Here you can purchase tickets to all the top attractions. Feel history come alive at the Independence National Historical Park, home to some of our nation’s most precious monuments, Independence Hall and the Liberty Bell. View more than 100 museums and attractions, such as the Betsy Ross House, Franklin Institute, Philadelphia Museum of Art and the Academy of Natural Sciences. Visit the Philadelphia Zoo, the Horticultural Center or enjoy the two outdoor performing arts centers. Dine at restaurants inspired by the world’s greatest collection of chefs--Wolfgang Puck, Emeril Lagasse, Bobby Flay and Thomas Keller, just to name a few. Treat yourself to a world-class show, including a choice of five Cirque du Soleil productions, the Blue Man Group and Jersey Boys. Make sure to also consider the variety of well-known headliners from the worlds of music, comedy and magic performing during your stay. Wherever you choose to spend your time in this city steeped in history and cultural heritage – shopping, sightseeing, fine dining – you are sure to enjoy every moment of your experience. To receive more information, contact The Philadelphia Convention & Visitors Bureau at (800) 537-7676 or visit the websites at www.pcvb.org and www.gophila.com. THE CONFERENCE WILL BE HELD AT THE SHERATON SOCIETY HILL One Dock Street, Philadelphia, PA 19106 Rates: $189 single/double RATES ARE PER ROOM AND SUBJECT TO PREVAILING STATE AND LOCAL TAXES. Special group rates are in effect from March 31 to April 5. Hotel room block release date is March 2, 2014. Reservations must include a first night’s deposit. For room reservations call (800) 325-3535, 24 hours daily. For additional hotel information, call the Sheraton Society Hill at (215) 238-6000. There’s never a dull moment in Las Vegas. Watch the volcano erupt at the Mirage, don’t miss the rousing pirate battle at Treasure Island, marvel at the dancing waters display at the Bellagio, take a romantic gondola ride through the canals of the Venetian or dine at the top of the Eiffel Tower at Paris. For a break from The Strip, take a day trip to Hoover Dam where you’ll be impressed with the power of the mighty Colorado River. THE CONFERENCE WILL BE HELD AT PARIS LAS VEGAS 3655 Las Vegas Blvd. South, Las Vegas, NV 89109 Rates: $159 single/double RATES ARE PER ROOM AND SUBJECT TO PREVAILING STATE AND LOCAL TAXES. Special group rates are in effect from April 25 to April 30. Hotel room block release date is March 27, 2014. Reservations must include a first night’s deposit. For room reservations call (877) 603-4389, 24 hours daily. For additional hotel information, call the Paris Las Vegas at (702) 946-7000.
  • 9. PSYCHIATRIC NURSING REGISTRATION FORM RETURN THIS ENVELOPE WITH FULL PAYMENT (U.S. FUNDS) REGISTER ONLINE 24/7 AT: CONTEMPORARY FORUMS.COM FAX THIS FORM TO: (800) 329-9923 Bar Code REGISTRATION INFORMATION (Please Print Clearly) *Name, License/Degrees, Place of Employment, City, State appear on your badge. *First Name PROFESSIONAL PROFILE Choose ONE category in each section that best applies to you. If you have multiple roles, select the one that occupies the majority of your time. Use “Other” only if none of the choices apply to you. 1. POSITION/ JOB FUNCTION R R R R R R R *Last Name *License/Degrees *Place of Employment *City *State Administrator/Director Case Manager Clinical Nurse Specialist Educator/Instructor Nurse Practitioner Nursing Management Private Practice/ Consultant R Social Worker R Staff/Charge Nurse R Other: __________ 2. CLINICAL SETTING Attendee’s email (Required) For confirmation, receipt, handouts prior to conference, and access to your Certificate of Attendance. Provide your best email address as some emails are filtered and blocked. Home Address City State Zip Daytime Phone(s) R Community Mental Health R General Hospital Inpatient Psych Unit R Long-Term Care R Military Clinic/Hospital R Outpatient Clinic/ Agency R Primary Care R Private Practice R Psych Emergency Services R Psychiatric Hospital R School of Nursing R Other: __________ 3. CLINICAL FOCUS R R R R R Adult Child/Adolescent Geriatric All Other: __________ 4. HIGHEST EDUCATIONAL LEVEL R R R R R R Diploma Associate Degree Bachelors Degree Masters Degree Doctoral Degree Other: __________ We collect this data in order to provide you with information about Contemporary Forums and conferences. If you prefer not to receive further information, please see our privacy statement at ContemporaryForums.com REGISTER ME FOR PAYMENT SUMMARY METHOD OF PAYMENT R Recorded Sessions (NOT ATTENDING, PHILADELPHIA CONFERENCE CON T EN T AVA I LA B LE VIA ONLINECELI B R A RY.COM) EARLY FEE POSTMARK DEADLINES: Philadelphia: 2/19/2014 Las Vegas: 3/17/2014 Make payment by check (payable to Contemporary Forums and enclose with Registration Form), Visa, MasterCard, Discover, American Express or Purchase Order. A $30 fee is charged for any returned check. Personal checks are NOT accepted at the conference. Purchase Orders must be received with registration by the conference date and include the P.O. number, invoice address, tuition, approval signature, contact name, email address and phone number. Recorded Sessions via OnlineCELibrary.com +$ PHILADELPHIA (#62) PHILADELPHIA R Preconference A (April 2 – A.M.) Preconference A +$ R Preconference B (April 2 – P.M.) AND/OR R Main Conference (April 3-5) Preconference B +$ OR LAS VEGAS (#67) Roundtable Lunch (#__ @ $35 each) +$ R Preconference A (April 27) R Preconference B (April 27) Main Conference $ R Main Conference (April 28-30) Group Discount* -$ CONCURRENT SESSIONS SELECTION Refer to individual conference schedules. Please indicate the letters and numbers of your choices below. #1 #2 #3 OR LAS VEGAS Preconference A OR B R Check/Money Order Payable to Contemporary Forums Credit Card # Exp. Date +$ Main Conference $ Group Discount* -$ TOTAL PAYMENT ENCLOSED Print Cardholder’s Name Billing Address $ *Registration forms must be sent in together. City Payer Email #4 Payer Phone # State Zip

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